Ignoring pain can lead to problems, hasten death for elderly

Ignoring pain can lead to problems, hasten death for elderly

Jane Brody

Updated 6:25 am, Wednesday, March 5, 2014

Into every life, a little pain must fall.

My friends and I, all well into our Medicare years, often joke that if nothing hurts, you must be dead. In truth, pain is not a normal part of aging, experts note, and should not be ignored.

Yet studies have found that elderly patients are less likely than younger adults to report pain to their doctors. Instead, many suffer in silence at considerable cost to the quality of their lives.

“The good news is that older people cope better with pain, but the bad news is that they cope by decreasing function and accepting pain as a consequence of aging,” wrote Dr. Bruce A. Ferrell, a UCLA geriatrician, and his co-authors in Primary Issues, a website for primary care doctors.

“Unfortunately, this may lead to a vicious cycle of declining functional status, worsening overall health, and neglect of remedial and treatable conditions, and ultimately resulting in needless suffering,” they wrote.

Dire consequences

Untreated or inadequately treated pain is disabling and can hasten the death of an older adult by interfering with the ability to exercise, eat properly or maintain social contacts. Persistent pain can lead to immobility, depression, sleep problems, loss of appetite and isolation, all of which may increase the need for expensive medical care.

As many as 60 percent of elderly people living at home experience considerable pain, as do up to 80 percent of those in nursing homes.

In a nursing team’s study of 124 older people (most between the ages of 71 and 90) living at home in North Carolina, only 10 percent reported having no pain in the previous month. Causes range from arthritic joints to chronic disease. Yet the underlying disorder may be correctable or, if not, treated to significantly relieve the pain it causes. There are nearly always safe and effective treatments to reduce pain.

Cautionary tale

A few weeks before Christmas, said Dale Bell, an active 75-year-old in Santa Monica, his shoulder and hip began to hurt. “I took ibuprofen, got a massage and eased off on my workout in the gym,” he said.

When that failed, he saw a doctor, who suggested physical therapy. But before Bell could begin, he and his family made a holiday trip to New York, during which the pain intensified, spreading from his shoulders to his knees.

“It was almost impossible to get out of bed and dressed in the morning,” he said.

Given a diagnosis of polymyalgia rheumatica in January, he was prescribed a steroid, a muscle relaxant and a long-acting pain reliever, along with physical therapy.

Bell is now back in the gym, gradually increasing the intensity of his workouts. He said he had been able to reduce his dependence on medication and felt he had gained the upper hand on his condition.

A mistaken belief that pain is inevitable is just one of many barriers to proper care for the elderly. Others include a reluctance to bother the doctor or be viewed as a complainer, concern about the need for additional tests, and fear that treatment will require surgery or medication that could lead to addiction.

Older patients with dementia may be unable to report or accurately describe their pain, and a failure to relieve their discomfort can result in aggression or other undesirable behaviors.

Once pain is recognized in an older person, the challenge is treating it properly.

Issues to address

Just as children, medically speaking, are not miniature adults, the elderly are not simply wrinkled versions of those much younger. Changes in body composition, organ function and metabolism affect how an older person responds to medication.

Kidney and liver function naturally decline with age, so avoiding toxic side effects may require using lower doses of pain relievers. Potent painkillers like opioids given at standard doses can build up in the blood of an elderly person, causing confusion and dementia-like symptoms.

Although drugs are often essential, there are other effective ways to treat pain.

Often helpful, either alone or with medication, are physical therapy, massage, strength training, relaxation exercises, yoga, acupuncture, water aerobics, alternating applications of heat and cold, meditation, self-hypnosis, and even listening to music and playing with a pet or children.

 

About bambooinnovator
Kee Koon Boon (“KB”) is the co-founder and director of HERO Investment Management which provides specialized fund management and investment advisory services to the ARCHEA Asia HERO Innovators Fund (www.heroinnovator.com), the only Asian SMID-cap tech-focused fund in the industry. KB is an internationally featured investor rooted in the principles of value investing for over a decade as a fund manager and analyst in the Asian capital markets who started his career at a boutique hedge fund in Singapore where he was with the firm since 2002 and was also part of the core investment committee in significantly outperforming the index in the 10-year-plus-old flagship Asian fund. He was also the portfolio manager for Asia-Pacific equities at Korea’s largest mutual fund company. Prior to setting up the H.E.R.O. Innovators Fund, KB was the Chief Investment Officer & CEO of a Singapore Registered Fund Management Company (RFMC) where he is responsible for listed Asian equity investments. KB had taught accounting at the Singapore Management University (SMU) as a faculty member and also pioneered the 15-week course on Accounting Fraud in Asia as an official module at SMU. KB remains grateful and honored to be invited by Singapore’s financial regulator Monetary Authority of Singapore (MAS) to present to their top management team about implementing a world’s first fact-based forward-looking fraud detection framework to bring about benefits for the capital markets in Singapore and for the public and investment community. KB also served the community in sharing his insights in writing articles about value investing and corporate governance in the media that include Business Times, Straits Times, Jakarta Post, Manual of Ideas, Investopedia, TedXWallStreet. He had also presented in top investment, banking and finance conferences in America, Italy, Sydney, Cape Town, HK, China. He has trained CEOs, entrepreneurs, CFOs, management executives in business strategy & business model innovation in Singapore, HK and China.

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